How to operate a successful spine practice in changing payer environment

Nicola Hawkinson DNP, RN -   Print  | Email

Decreasing reimbursements for spine surgeons and maintaining workflow efficiency are concerns in a changing payer environment. Spine surgeons are looking to overcome lower reimbursements and collect revenue by using skilled billers and coders while keeping costs down. Here are four ways to keep your spine practice thriving:



2015 was the deadline for physicians to adopt and make meaningful use of EMR systems if not, Medicare reimbursements will be reduced by 1 percent with the deduction rate increases in subsequent years by 2 percent in 2016, 3 percent in 2017, 4 percent in 2018 and up to 95 percent depending on future adjustments. Aside from being a cost saving measure, EMR has the potential to add more protection for patients as well as physicians.




Having a well-trained and experienced billing team is perhaps the most important indirect driver of revenue at your practice. Billers and coders who are credentialed and certified from reputable professional associations not only know how to code for the highest revenue and understand best practices about billing that can help you avoid an audit, but also are better informed about important industry that can impact your revenue and operations. Moreover, credentialed professionals can apply advanced principles that are likely to make a true difference in your cash flow, including benchmarking practices, analyzing remittance data to find variances from your payer contracts and proactively uncovering or reverse-engineering payer rules.


Workflow Issues


Your revenue cycle workflow includes the activities within your practice related to billing. Front office tasks like verifying insurance or collecting co-pay, documentation of the visit using appropriate diagnosis and procedure codes and activities related to submitting the claim and then managing the collections process are all linked together like a chain. Just one small kink in the chain can throw off your revenue cycle and generally wreak havoc.


Having cohesive front and back office billing functions improves revenue because it creates time efficiencies, aids communication and allows for appropriate oversight of coding and other billing processes.




Your reimbursements on claims filed and the money paid out of pocket by patients are the basis of your revenue cycle. The extent to which you effectively manage your payment processes and have a handle on collecting payments that are past due is an indicator of your practice’s financial health. While this makes sense intuitively, actual execution of effective revenue cycle management is a challenge to the average practice owner. Not only is the U.S. healthcare payment system designed to work against you, but you may otherwise lack the time, expertise or internal systems to ensure that you get paid the maximum you are owed as quickly as possible. Having appropriate technology, adequate workflow and experienced billing personnel are important steps on the path toward a prosperous and efficient practice. The more that you can eliminate barriers, the stronger influence you can have over financial outcomes.


More articles on orthopedic practices:
The next wave of orthopedic independent practice—Integrative care
Remote orthopedic care: Can it be quality & cost effective?
10 things about social media in healthcare: Who's using it? Does it make a difference?

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